| 叶立红,王翀奎,赵亮亮,等.药物性胆管消失综合征 45例临床病理特点及预后分析[J].安徽医药,2019,23(10):2073-2077. |
| 药物性胆管消失综合征 45例临床病理特点及预后分析 |
| Clinicopathological features and prognostic analysis of 45 cases with drug?vanishing bile duct syndrome |
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| DOI：10.3969/j.issn.1009?6469.2019.10.043 |
| 中文关键词: 药物性肝损伤，慢性 胆汁淤积 胆管消失综合征 药物相关性 预后 临床病理特征 |
| 英文关键词: Drug?induced liver injury,chronic Cholestasis Clinicopathological characteristics |
| 基金项目:石家庄市科学技术研究与发展指导计划课题( 151460903) |
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| 中文摘要: |
| 目的探讨与药物性胆管消失综合征((drug?vanishing bile duct syndrome，D?VBDS)预后相关的临床、病理组织学及肝生化学特点。方法采用回顾性研究方法选取 2003年 1月至 2017年 12月石家庄市第五医院经肝穿刺病理明确诊断为 D?VBDS的 45例病人，根据再次追踪随访的肝生化指标及临床症状体征情况，将其分为预后转归好与差分为两组，对比分析两组病人的性别构成、发病年龄、用药史、病理形态学特点及血清学指标等数据，并对病理形态学特点进行半定量评分。结果 31例 D?VBDS病人预后较好， 14例 D?VBDS病人预后较差。两组在性别构成( χ2＝0.106，P＝0.745)及发病年龄( t＝2.988，P＝0.394)比较，均差异无统计学意义( P＞0.05)均以 40~60岁女性最多见。中药及中成药是引起 D?VBDS最主要的药物( 51.1%)，其次为阿奇霉素( 11.1%)及解热镇痛药( 9.0%，)。肝生化各指标高峰值比较，预后差组总胆红素( TBil)、直接胆红素( DBil)、总胆汁酸( TBA)、球蛋白( GLB)、总胆固醇( TG)(t＝6.436，P＝0.000；t＝5.847，P＝0.000；t＝3.569，P＝0.033；t＝2.381，P＝0.031；t＝ 2.328，P＝0.041)水平明显高于预后好组，白蛋白( ALB)、胆碱酯酶( CHE)(t＝2.445，P＝0.020；t＝3.003，P＝0.012)水平明显低于预后好组，差异有统计学意义( P＜0.05)。两组病理形态学特点对比显示，汇管区炎症和纤维化、胆盐淤积、细胆管增生及毛细胆管淤胆评分( t＝2.437，P＝0.017；t＝4.416，P＝0.001；t＝4.214，P＝0.001；t＝3.050，P＝0.006；t＝2.716，P＝0.009)两组差异有统计学意义( P＜0.05)。结论影响 D?VBDS预后的因素与胆管损伤的级别、范围、胆管再生修复状况等因素有关。血清 TBil、DBil、TBA、TC、GLB水平的持续升高及 ALB、CHE水平持续降低可作为预测预后的肝生化学指标。肝组织中汇管区炎症和纤维化程度、胆盐淤积程度、细胆管增生程度及毛细胆管淤胆程度为与预后相关的病理形态学特点，肝穿组织病理检查结果仍是明确诊断及判断预后的金标准。 |
| 英文摘要: |
| Objective To explore the prognosis?related clinical，histopathological and hepatic biochemical characteristics of pa? tients with drug?vanishing bile duct syndrome(D?VBDS).Methods The retrospective research method was used to select 45 pa?tients of D?VBDS who were diagnosed by liver biopsy at The Fifth Hospital of Shijiazhuang from January 2003 to December 2017， and assign them into good prognosis group and poor prognosis group according to the liver biochemical index and clinical symptomof follow?up.Comparison was made between the two groups of patients’gender composition，mean age of onset，history of medica? tion，pathomorphological characteristics and serological indicators.And semi?quantitative scoring of pathomorphological characteris?tics was conducted.Results 31 D?VBDS patients had good prognosis and 14 D?VBDS patients had poor prognosis.There were nostatistically significant differences in gender composition(χ2＝0.106，P＝0.745)and mean age of onset(t＝2.988，P＝0.394)be? tween the two groups(P＞0.05).The most common patients were women aged 40 to 60.Traditional Chinese medicine and Chinesepatent drugs are the main drugs that caused D?VBDS(51.1%)， followed by Azithromycin(11.1%) and antipyretic analgesic(9.0%).As for the peak value of hepatic biochemical indexes，the levels of total bilirubin(TBil)，direct bilirubin(DBil)，total bile acid(TBA)，globulin(GLB)and total cholesterol(TG)of the poor prognosis group were significantly higher than those of the good prognosis group(t＝6.436，P＝0.000；t＝5.847，P＝0.000；t＝3.569，P＝0.033；t＝2.381，P＝0.031；t＝2.328，P＝0.041)， while the levels of cholinesterase(CHE)and albumin(ALB)of the poor prognosis group was significantly lower than those of the good prognosis group(t＝2.445，P＝0.020；t＝3.003，P＝0.012).The differences were statistically significant(P＜0.05).As for the pathomorphological characteristics of the two groups，there were significant differences in the scores of inflammation and fibrosis in portal area，chlolatestasis，ductule proliferation and bile canaliculus cholestasis(t＝2.437，P＝0.017；t＝4.416，P＝0.001；t＝4.214， P＝0.001；t＝3.050，P＝0.006；t＝2.716，P＝0.009)between the two groups(P＜0.05).Conclusions The prognosis of D?VBDS are related to the grade and scope of bile duct injury，the status of bile duct regeneration and repair.The continuous increase of se? rum TBil，DBil，TBA，TC and GLB levels and the continuous decrease of ALB and CHE levels can be used as hepatic biochemicalindicators for predicting prognosis.The pathomorphological features associated with prognosis include the degree of inflammationand fibrosis in the portal area，cholestasis，bile ductule hyperplasia and cholestasis of bile canaliculus.The results of pathological ex?amination of liver biopsy is still the gold standard for definite diagnosis and prognosis prediction. |
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